Not urgent?

[ESaN]

I have been feeling poorly for a few months and my mum suggested I get a HbA1C test (she had T2 and I had gestational diabetes).

Results came back today and are 51mmol.

However, there has been no follow up from GP and when I called the surgery they advised me their next appointment is 21st July to see the diabetes nurse!

I am new to this, mum’s away (lucky her) so I don’t want to bother her, so is it not urgent? Do I have to struggle day-to-day until the 21st July? I have already lost 2 stone in the last 4 or so months, eating healthily, exercising almost everyday and I don’t feel better, I’m napping twice a day and I may as well be connected to both the kitchen tap and the toilet. I feel at a loss and worried that I have to continue like this.

Perhaps T2 isn’t as serious as I am imagining and I’m making a fuss?

 

[ESaN]

I should probably also add that my liver function came back abnormal too and the GP was straight on the phone booking me a test for four weeks time. I imagine the abnormal liver function is to do with the diabetes? I’m very confused!

 

[Drummer]

@ESaN Those symptoms seem rather severe for a Hba1c that low. It is only just into the diabetes range.
It could be that things are changing rapidly.
Do you have a testing meter and any in date test strips? It might be advisable to check your blood glucose levels to see how high they are at the moment.
I did wonder if the 'healthy' diet might be the same as the one I was pressured to follow - really high in carbs and low in fat - I felt dreadful, but I did put on a lot of weight rather than losing it.

 

[rebrascora]

Hi and welcome.

An HbA1c result of 51 doesn't generally require urgent medical attention and in realisty, doesn't require medical attention at all because you should be able to resolve it with dietary changes however I would agree with @Drummer above that it should not be causing the symptoms you are experiencing. The kidneys don't generally kick in until BG levels are mid teens but that would give you an HbA1c significantly higher than 51, so the weeing and thirst/drinking may not be to do with diabetes as we know it, unless that HbA1c result is incorrect.... errors happen..... or these symptoms have just started in recent days and not had time to show fully in your HbA1c result..... which is an indication of your Blood Glucose over the past 3 months, so the last few days would only have a minimal impact.
Like Drummer, I would suggest you get hold of a meter and in date test strips and do some finger prick testing before and 2 hours after meals and see what sort of results you get. If you are getting readings under 10 most of the time then would be pushing for further investigation of your symptoms. Anemia or vitamin B12 deficiency could be causing the extreme fatigue. Perhaps an infection causing the weeing and drinking or perhaps hormonal.

It would do you no harm to start reducing your carbohydrate intake straight away though to help reduce that HbA1c. Unfortunately, healthy eating is a confusing term and what is healthy for one person may not be healthy for another. Two quite classic examples are fruit and porridge/oats. Both considered very healthy but may not do your blood glucose levels any favours. Oats, like other grains are about 60% carbohydrate and fruit is also full of sugar. Most of us who follow a low carb way of eating restrict our fruit intake to a few berries like rasps, strawberries, blackberries, blackcurrants, sour cherries or currently stewed rhubarb (with a little sweetener) since it is in season and an occasional half an apple or kiwi or plum.

Low carb is cutting right back on added sugar and sweet stuff but also reducing portion size and frequency of bread, pasta, rice and potatoes, breakfast cereals and all the other stuff made with grain products (like breakfast cereals) and replacing with a bit more fat, dairy, eggs, meat and leafy green veg.

 

[Inka]

Did they do other tests as well as the liver and HbA1C @ESaN ? Thyroid problems, anaemia and a host of other things can make you feel tired. An HbA1C of 51 shouldn’t be making you feel so bad.

If you are ‘just’ Type 2, then waiting till July 21st is ok. Your HbA1C will be amongst the lowest of all the Type 2 patients. However, in the meantime, it would be worth you getting a blood glucose meter and doing some testing at home. That way you can see if your tiredness linked to your blood sugar and you can also see how certain meals affect your blood sugar.

 

[Lucyr]

I am new to this, mum’s away (lucky her) so I don’t want to bother her, so is it not urgent? Do I have to struggle day-to-day until the 21st July?

With an a1c of 51 you don’t urgently need medication no, likely recomendation is to improve blood sugar through diet, exercise and weight loss for at least 3 months to see how that affects your a1c.

 

[everydayupsanddowns]

I have already lost 2 stone in the last 4 or so months, eating healthily, exercising almost everyday and I don’t feel better, I’m napping twice a day and I may as well be connected to both the kitchen tap and the toilet. I feel at a loss and worried that I have to continue like this.

Sorry to hear about the confusing time you are having @ESaN

The symptoms you describe could be serious. Unintended weight loss, extreme thirst, tiredness, and fatigue are the ‘4 Ts’ of type 1 diabetes (tired, thirsty, toilet, thinner).

But your recent HbA1c of 51 doesn’t seem to match - and probably explains your surgery’s relatively relaxed attitude (51 is only just over the threshold for a diagnosis with diabetes).

I wonder if it might help to call NHS 111 with your symptoms and your worries?

 

[ESaN]

So I have been checking my blood glucose at home for the last 3 weeks ish. My fasting blood has been between 8 and 10, 2 hours after meals between 14-16.

I had a full blood count done too, everything was satisfactory.

I have been following a similar diet to my mum for 4 months who has been T2 for a long time and has been successful in weight loss and bringing down her HbA1C. I’ve lost about two stone and I do regular exercise when I don’t feel ready to collapse into bed for some hibernation.

Seems I’m worrying about nothing. Anxiety is one of my traits! I’ll continue with the diet and just help myself as best I can. Grateful I’m not all that diabetic!

Thanks so much for the help

 

[Leadinglights]

So I have been checking my blood glucose at home for the last 3 weeks ish. My fasting blood has been between 8 and 10, 2 hours after meals between 14-16.

I had a full blood count done too, everything was satisfactory.

I have been following a similar diet to my mum for 4 months who has been T2 for a long time and has been successful in weight loss and bringing down her HbA1C. I’ve lost about two stone and I do regular exercise when I don’t feel ready to collapse into bed for some hibernation.

Seems I’m worrying about nothing. Anxiety is one of my traits! I’ll continue with the diet and just help myself as best I can. Grateful I’m not all that diabetic!
meal
Thanks so much for the help

Those levels are actually quite high especially your post meal readings so I suspect the diet you are following is not suitable for YOU, it might be for your Mum but she may be taking medication and may be different in her tolerance of carbohydrates.
Levels as high as that might well be making you have the symptoms you are getting even though not reflected in your HbA1C.
I would be looking to reduce your carbohydrate intake to try to get those post meal levels down. You are aiming at no more than 8-8.5mmol/l and fasting levels of between 4 and 7mmol/l.
Have a look at this link to see how it compares with the regime you have been following, I think some prompt change is wise so not waiting until your appointment.
If you would like to share the sort of meals you are having then people may spot some obvious problem foods.

 

[ESaN]

So I follow a Mediterranean diet which is similar to my mum although she has more potato with her meals whereas I’ve cut those down, maybe 3-4 new potatoes 2 or 3 times a week.
Chicken or fish (I don’t eat red meat) with most and any vegetables. I’ve never had a sweet tooth, but crisps used to be my go-to. I’ve cut those out completely for about 8 weeks. I drink tea with semi-skimmed milk and sweetener. And lots of water.
Breakfast is usually weetabix, with a small banana and semi-skimmed milk.
Todays lunch was salmon, lettuce, tomato, cucumber, spring onions and feta.
Todays dinner was roasted chicken breast and a mix of roasted vegetables - red onion, cherry tomatoes, green pepper, yellow pepper and 3 new potatoes (2nd time this week for potatoes) and some peas and sweetcorn.
Too hot today and didn’t feel like a snack. But if I snack it would be something like carrots and hummus or homemade roast chickpeas cooked in fry-light olive oil and herbs or spices.
Exercise - walking everyday about 30 mins. Cycling twice a week, walking rugby once a week. I try to force myself to do these even if I have limited energy. But sometimes it beats me.

 

[Inka]

That seems a pretty healthy and moderate diet @ESaN If you want to reduce the carbs further, you could cut out your breakfast banana and add some blueberries or raspberries maybe. There are also lower carb milks. But there’s nothing that screams excess about your diet. Perhaps your changes will be enough to bring your HbA1C down? When is your next test?

 

[Leadinglights]

So I follow a Mediterranean diet which is similar to my mum although she has more potato with her meals whereas I’ve cut those down, maybe 3-4 new potatoes 2 or 3 times a week.
Chicken or fish (I don’t eat red meat) with most and any vegetables. I’ve never had a sweet tooth, but crisps used to be my go-to. I’ve cut those out completely for about 8 weeks. I drink tea with semi-skimmed milk and sweetener. And lots of water.
Breakfast is usually weetabix, with a small banana and semi-skimmed milk.
Todays lunch was salmon, lettuce, tomato, cucumber, spring onions and feta.
Todays dinner was roasted chicken breast and a mix of roasted vegetables - red onion, cherry tomatoes, green pepper, yellow pepper and 3 new potatoes (2nd time this week for potatoes) and some peas and sweetcorn.
Too hot today and didn’t feel like a snack. But if I snack it would be something like carrots and hummus or homemade roast chickpeas cooked in fry-light olive oil and herbs or spices.
Exercise - walking everyday about 30 mins. Cycling twice a week, walking rugby once a week. I try to force myself to do these even if I have limited energy. But sometimes it beats me.

I looks as if I forgot to post the link. https://lowcarbfreshwell.co.uk/
The foods that many would not be able to tolerate would be your breakfast as both the weetabix and banana are high carb so you are starting the day with maybe a higher level than is desirable.
Also the veg you are having in todays dinner are a combination of high carb veg, potatoes, peas, sweetcorn so that ay be increasing blood glucose by more than you want.
It would be a good idea to check out those meals with your blood glucose monitor to see if they are Ok.

 

[Dragonheart]

So I have been checking my blood glucose at home for the last 3 weeks ish. My fasting blood has been between 8 and 10, 2 hours after meals between 14-16.

An hba1c of 51 is the equivalent of having a constant level of 8.3. Now obviously no one’s blood glucose is static like that but your levels all seem to be above that and some quite considerably which suggests things might be changing quite quickly in the wrong direction. That is not typical for type 2. If you check and adjust your meals and still are getting levels such as you are then I’d be calling back and asking to see someone sooner than late July in case it’s actually type1 (it’s not just kids and it’s not always sudden in a matter or days/weeks. In adults type 1 can come on over months/years, even more so when diet is restricting carbs thus mitigating the effects for a while).

Personally I find that I cannot eat weetabix, bananas, potatoes, sweetcorn or many peas. Some people react quite strongly to tomatoes, onions and chickpeas. Whilst not obviously really high carb items they aren’t the lowest either and many of us find we have particular “kryptonite” foods that pack a bigger punch than expected. So I second testing before and after any meals containing these items to see their effect on you.

 

[TheClockworkDodo]

An hba1c of 51 is the equivalent of having a constant level of 8.3. Now obviously no one’s blood glucose is static like that but your levels all seem to be above that and some quite considerably which suggests things might be changing quite quickly in the wrong direction. That is not typical for type 2. If you check and adjust your meals and still are getting levels such as you are then I’d be calling back and asking to see someone sooner than late July in case it’s actually type1 (it’s not just kids and it’s not always sudden in a matter or days/weeks. In adults type 1 can come on over months/years, even more so when diet is restricting carbs thus mitigating the effects for a while).

I second that - if you keep getting high levels, especially if they are getting higher rather than lower, you should be asking for tests in case it's type 1 - GPs often don't know much about type 1 and may not realise that adults can get it. The tests to ask for are GAD antibody and C-Peptide.

In the meanwhile if you keep getting readings over 14 it would be worth getting yourself a pot of Ketostix (some pharmacies stock them or will order them in for you, or you can get them online, I think they cost about £5) and testing your urine for ketones, because if you have type 1 you're at risk of Ketoacidosis, and you do already have some of the symptoms (the ones which overlap with just having high blood sugar) - more info here so you can keep an eye out to make sure you don't get any of the others - https://www.diabetes.org.uk/guide-to-diabetes/complications/diabetic_ketoacidosis

 

[ESaN]

I second that - if you keep getting high levels, especially if they are getting higher rather than lower, you should be asking for tests in case it's type 1 - GPs often don't know much about type 1 and may not realise that adults can get it. The tests to ask for are GAD antibody and C-Peptide.

In the meanwhile if you keep getting readings over 14 it would be worth getting yourself a pot of Ketostix (some pharmacies stock them or will order them in for you, or you can get them online, I think they cost about £5) and testing your urine for ketones, because if you have type 1 you're at risk of Ketoacidosis, and you do already have some of the symptoms (the ones which overlap with just having high blood sugar) - more info here so you can keep an eye out to make sure you don't get any of the others - https://www.diabetes.org.uk/guide-to-diabetes/complications/diabetic_k

I second that - if you keep getting high levels, especially if they are getting higher rather than lower, you should be asking for tests in case it's type 1 - GPs often don't know much about type 1 and may not realise that adults can get it. The tests to ask for are GAD antibody and C-Peptide.

In the meanwhile if you keep getting readings over 14 it would be worth getting yourself a pot of Ketostix (some pharmacies stock them or will order them in for you, or you can get them online, I think they cost about £5) and testing your urine for ketones, because if you have type 1 you're at risk of Ketoacidosis, and you do already have some of the symptoms (the ones which overlap with just having high blood sugar) - more info here so you can keep an eye out to make sure you don't get any of the others - https://www.diabetes.org.uk/guide-to-diabetes/complications/diabetic_ketoacidosis

I have so much to learn and it feels all so complicated right now. I don’t have a follow on from this HbA1C until my appointment at the end of July with the diabetes nurse. I’m really glad I came here because I didn’t realise those things could be an issue for me. I thought losing weight would be my main goal and make me feel better and I’ve done that, but not in the right way for me it seems. Back to square one I feel.

I had a ketone blood test last week when I had my HbA1C. It was normal.

I think I need to go back to the drawing board with this advice and figure it all out again. Thanks so much for everyone’s help

 

[Drummer]

I have so much to learn and it feels all so complicated right now. I don’t have a follow on from this HbA1C until my appointment at the end of July with the diabetes nurse. I’m really glad I came here because I didn’t realise those things could be an issue for me. I thought losing weight would be my main goal and make me feel better and I’ve done that, but not in the right way for me it seems. Back to square one I feel.

I had a ketone blood test last week when I had my HbA1C. It was normal.

I think I need to go back to the drawing board with this advice and figure it all out again. Thanks so much for everyone’s help

Having seen your typical meals, I wonder if it could be the time of day the carbs are eaten which is throwing things off.
Your breakfast, when many people find that they don't deal with carbs as well as at other times of day, seems particularly high carb, so perhaps altering that could mean you get through the rest of the day more easily.

 

[ESaN]

I’ve stopped the Weetabix and banana. This morning it was Greek yoghurt and a few raspberries.

 

[Dragonheart]

I’ve stopped the Weetabix and banana. This morning it was Greek yoghurt and a few raspberries.

And what did the meter show before and after this breakfast?

 

[Tdm]

I’ve stopped the Weetabix and banana. This morning it was Greek yoghurt and a few raspberries.

Sounds both tasty and low carb!

 

[TheClockworkDodo]

I have so much to learn and it feels all so complicated right now. I don’t have a follow on from this HbA1C until my appointment at the end of July with the diabetes nurse. I’m really glad I came here because I didn’t realise those things could be an issue for me. I thought losing weight would be my main goal and make me feel better and I’ve done that, but not in the right way for me it seems. Back to square one I feel.

I had a ketone blood test last week when I had my HbA1C. It was normal.

I think I need to go back to the drawing board with this advice and figure it all out again. Thanks so much for everyone’s help

Please don't worry about it all being complicated at first - everyone always says that diabetes is a marathon, not a sprint, and in time it will become second nature. No-one can take it all in at once. You have made a really good start though, you have what sounds like a healthy diet (especially without the bananas), and you're doing the right things in terms of eating healthily and exercising, which are the best things to do if you have type 2. And you're testing your blood sugar so you can find out how different foods effect you - a lot of type 2s aren't told to do this (or in some cases told not to do this) and because different foods effect different people in different ways it's really essential.

It's best to test just before a meal and then about 2 hours after the meal so you can see how the foods in that meal effect you, test each meal a few times just to make sure there are no anomolies, and cut out or cut down on any foods which spike your blood sugar.

Everything you change has to be sustainable in the long-term, so if you are forcing yourself to do particular forms of exercise when you don't feel like it you might want to see if you can find something else which feels less of an effort. Swimming? Gardening? Whatever you enjoy which gets you moving about.

I'm glad to hear your blood ketone test was normal, but please do keep an eye out as ketones can develop quite quickly, and if you do turn out to have type 1 the diet and exercise (while still good for you generally) won't effect it. It's only a slight concern that it might be type 1 because your blood sugar readings are so much higher than your HbA1c suggests they should be and you are so thirsty and so tired, just something to bear in mind in case your levels keep going up rather than going down.